Imperative hallucinations

Auditory or as they are also called imperative hallucinations. Specialists most often have to deal with complaints of this nature. The sounds and noises that the patient hears are quite varied. These can be abrupt, unclear sounds or distinct whole phrases, knocking, scratching sounds, a lonely voice or a cacophony of voices. The level of noise in the head can be slightly distinguishable or very loud, unfamiliar or familiar. Most often, these sounds frighten the patient. They threaten him, promising to punish; frighten; subjugate him, forcing him to follow their orders. Such psychological pressure morally breaks the "victim". He begins to unconditionally follow the commands sounding in his head.

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Causes of imperative hallucinations

In "banal" neuroses, auditory delirium usually does not manifest itself. Therefore, the appearance of hallucinations in a person indicates serious changes that affect individual areas of the human brain. Analyzing the clinical picture in each individual case, a qualified doctor tries to determine the source that became the catalyst for the disease.

Today, doctors name only a few reasons for imperative hallucinations, but some of them remain beyond human understanding.

Alcoholism. People suffering from this disease (especially for a long time) are quite susceptible to auditory hallucinations. They are expressed in the appearance of a voice "in the head" of the alcoholic, which addresses him, calling for a conversation. But most often, there are several voices, they communicate with each other, "discussing the patient, commenting on his actions", causing panic in the patient. Against the background of such a mental disorder, it is almost impossible to predict the further actions of such a person.

Schizophrenia is a psychotic personality disorder. The auditory transformation in this case is directed directly to the patient. The voice communicates with him, gives orders.

These are the most common sources. But there are many more. For example, similar symptoms can be provoked by sexually transmitted diseases, such as neurosyphilis.

People who use drugs also suffer from severe auditory cacophony.

The body ages, pathological changes occur in it, which can lead to the development of senile paranoia, which can also cause a similar symptom in the victim.

In the list of primary causes of imperative hallucinations, it is necessary to note amentia - a very severe form of clouding of consciousness, expressed in a negative transformation of speech sound, "distortion" of thinking and worldview. The whole danger of this disease is that such a multifaceted distortion is quite capable of leading the patient to death.

Doctors classify imperative hallucinations as verbal deviations.

Having established the cause of pathological changes, a qualified doctor is able to predict the outcome of treatment therapy.

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Symptoms of imperative hallucinations

From Latin imperatum – is translated as to order, therefore the terminology under consideration denotes pathological auditory sounds that are perceived by the patient as orders forcing him to perform this or that action. Most often, the symptoms of imperative hallucinations are expressed in the patient receiving such orders that have a criminal-sadistic coloring, making the patient dangerous both for himself and for the people around him. The voice addresses the person directly, giving commands: “take an axe, cut off your hand...”, “climb onto the window, jump...”, “take a rope and throw it around the neck of the demon who is nearby...”

Patients who have not yet completely lost their minds share their fears with the doctor. They are very afraid that during the next attack the voices will order him to cause physical harm to one of his loved ones. After all, during an attack, a person loses control over his brain, the will is suppressed so much that he cannot resist the voices - it does not even occur to him.

Mostly the voice directly addresses the patient, but it does not call the patient by name. Rarely do voice commands concern abstract or long-term actions; usually such orders concern the situation "here and now".

Mostly the patient hears such whispers with both ears, but there are known cases when sound perception comes from one side. Mostly a person begins to hear voices at night, against the background of absolute silence.

A very similar picture arises when the patient is under hypnosis, in a state of deep trance.

Diagnosis of imperative hallucinations

If people around you and your loved ones suspect that someone nearby is suffering from the pathology discussed in this article, you should consult a qualified psychiatrist.

His diagnosis of imperative hallucinations usually begins with the fact that he makes sure that the patient suffers from a pathology, and that his conversations and stories are not an illusion or a simple fantasy.

After all, auditory suggestion is sound structures that arise in the consciousness of a sick patient in the absence of an external stimulus. People with a history of this pathology differ from "dreamers" in that the latter can easily be convinced otherwise. Whereas it is impossible to convince psychiatrists' patients of the unreality of sound cacophony.

If a person sees a wardrobe changing shape under the influence of a light effect or other factors, turning into an angry bear, then this is an illusion, a mirage in the desert is an illusion. But if a person is convinced of the presence of a cat in an empty corner, then this is a hallucination. Similar tests are also available for identifying imperative hallucinations.

An important method of diagnosing the disease is visual observation of the patient's behavior by specialists. It is this monitoring that allows the doctor to confirm the disease and determine its form of manifestation.

Pathological attacks can manifest themselves episodically; in severe forms of mental disorder, a person can completely immerse himself in such a state. It is very important to prevent such a transition.

The psychiatrist also very carefully monitors changes in facial expressions, since the emotional manifestations of a sick person, expressed by changes in facial expressions, are not commensurate with the situation around him. For example, against the background of complete grief, such a patient is able to enjoy life, laugh... Or against the background of complete calm, for example, a sunny morning, birds are singing, and the patient is in a state of panic, fear, anger...

The most pronounced symptom of auditory hallucinations is the patient's desire to cover his ears, hide his head under the pillow, so as not to hear the annoying and frightening whisper. At the same time, the environment does not provide prerequisites for such actions.

There have been cases where sick people, in horror, covered their ears with their hands, rushed headlong to run, not looking at the road, getting hit by cars, falling out of windows. Mostly, such manifestations are rarely observed in isolation, more often complex changes occur, in which auditory pathology is combined with other symptoms, for example, delirious states.

Sometimes healthy people are also susceptible to illusions, while the appearance of hallucinatory sounds is an undoubted indicator of mental pathology, which requires urgent emergency medical care.

Greater attention to your close relatives and friends will allow you to recognize the disease in time, because a person, finding himself in such a situation, fearing not to be understood and stopped by the fear of being placed in a psychiatric hospital (or for some reason known only to him) tries to hide the delirious state, dissimulate it in his everyday life.

The hallucinating person becomes more alert, focused, constantly on guard so as not to reveal his condition. But when the early stage of the disease's progression is missed, the person gradually begins to communicate with his imaginary interlocutor, answering his questions out loud.

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Treatment of imperative hallucinations

If a person encounters such a pathological situation for the first time, it plunges him into a stupor and horror. But the main thing to remember is that what is happening is a manifestation of his reality for the hallucinating person. Therefore, the first thing that his close relatives need to remember is how to behave correctly in this situation and what help they can provide to their neighbor.

1. Under no circumstances should you even try to dissuade the patient that everything that is happening to him is a reality transformed by the psyche.
2. You should show tact, patience, and in many ways, imagination, in order to, first of all, calm down an excited and shocked person. For example, if he is absolutely sure that werewolves are trying to get into his window at night, do not laugh, just take an active part in finding the means and ways to physically protect himself from the threat (bring an aspen branch from the street, put an icon in the room, give a pectoral cross, etc.).
3. It is necessary to use such attributes and try to create an atmosphere and environment such that the hallucinations that arise do not cause such horror, that is, to soften the emotional intensity and negative coloring as much as possible.

At the same time, what is absolutely forbidden for others to do is:

• Make fun of the "suffering" person.
• Show your irritation and discontent when the patient begins to show any concerns. Be glad that your loved one shows trust and asks for help, otherwise, he will simply withdraw into himself, trying to contain the growing internal horror. But such a situation cannot last forever, there will come a moment when "an explosion occurs", and even an experienced psychiatrist cannot predict how this attack will end.
• Give up the futile task of trying to convince the hallucinating person that this is a figment of his inflamed mind.
• You shouldn’t focus your and his attention on this problem and try to find out who is talking to him, what the source of the sound is.
• During an attack, it is especially necessary to monitor your emotions, do not raise your voice and talk too loudly. During this period, it is necessary to create the illusion for the patient that those around him are doing everything to help him and "save" him.
• Calm, soothing music, a change of scenery, and, in special cases, medications, which should only be prescribed by a qualified specialist, can help reduce agitation somewhat.

But no matter how attentive the relatives are to the "victim", he simply needs qualified medical care. By contacting a specialist, a diagnosis will be made, recommendations will be given and adequate therapy will be prescribed.

Today, treatment of imperative hallucinations is carried out using several methods, but all of them are mainly aimed at eliminating pathological attacks and bringing the patient out of a delirious state.

The treatment protocol usually includes such pharmacological drugs as tizercin, chlorazine, contomin, plegomazine, gibanil, thorazine, chlorpromazine hydrochloride, aminazine, largactil, chlorpromazine, phenactil, ampliactil, gibernal, promactil, propafenine, megafen, clopram or ampliktil.

The antipsychotic, neuroleptic drug chlorpromazine is usually administered intramuscularly or intravenously.

For intramuscular administration, the single maximum dosage is 0.15 g, during the day - 0.6 g. The recommended schedule of administration is usually represented by the prescription of one to five milliliters of a 2.5% solution, but no more than three procedures during the day.

In case of an acute attack of the disease, the doctor prescribes intravenous administration of the drug. In this case, two to three milliliters of a 2.5% solution are diluted with 20 ml of a 40% glucose solution before administration. With this method of administering the drug to the body, the single maximum dosage is 0.1 g, during the day - 0.25 g.

When stopping an attack at home, a psychiatrist can prescribe drugs of this group in the form of tablets or dragees. Aminazine is taken orally immediately after meals (this will reduce the level of irritation of the mucous membrane of the digestive tract). The starting daily dosage of the drug is 25 - 75 mg, divided into one, two or three doses.

Contraindications for the use of this drug in the treatment protocol include:

• Individual intolerance of the patient's body to one or more components of the drug.
• As well as a history of cardiovascular decompensation.
• Ulcerative and erosive lesions of the stomach and duodenum.
• Serious pathological changes in the functioning of the liver and kidneys.
• Severe hypotension.
• Problems with the stomach.

At the same time, the doctor prescribes haloperidol, senorm, haloper, trancodol-5 or trisedyl.

A neuroleptic belonging to the derivatives of butyrophenone, haloperidol is prescribed to the patient orally 30 minutes before the expected meal. To reduce the level of irritation of the mucous membrane of the digestive organs, the drug can be taken together with a sufficient amount of milk.

The initial daily recommended dosage (depending on the clinical picture and intensity of the attack) is prescribed within the range of 0.5 to 5 mg, divided into two or three doses. The dosage is gradually increased by 0.5 to 2 mg until the expected therapeutic effect is achieved. In particularly severe cases, the dosage increase may be from 2 to 4 mg.

The maximum permissible amount of the drug that is allowed in daily intake is determined by the figure of 100 mg.

In most cases, therapeutic effectiveness in relieving an attack can be achieved with daily doses of 10–15 mg.

If the patient has a chronic form of schizophrenia, then the problem can usually be relieved with daily doses of 20–40 mg.

In resistant cases, with a particular intolerance of the patient’s body to the drug, the quantitative component of its administration can stop at 50–60 mg.

The maintenance dosage, which the patient takes between attacks, is 0.5 to 5 mg per day. These figures are reduced very carefully and gradually.

The duration of treatment therapy can take on average two to three months.

If the disease is diagnosed in children aged 3 to 12 years, whose body weight falls within the range of 15 to 40 kg, the dose of the administered drug is calculated from 0.025 to 0.05 mg per kilogram of the little patient's weight, divided into two or three doses. The dosage can be increased no more than once every five to seven days. The maximum permissible daily administration of the drug should not exceed 0.15 mg per kilogram of the patient's weight.

For elderly people suffering from imperative hallucinations, the amount of the drug administered is reduced and half or even a third of the recommended adult dose is administered. The dosage can be increased no more than once every two to three days.

If necessary, the attending physician may prescribe this drug in another form: oral drops, solution for intravenous or intramuscular injections.

It is not recommended to use the drug in question in the treatment protocol if the patient suffers from Parkinson's disease, central nervous system depression, basal ganglia damage, depressive disorders and if the patient is under three years old, as well as in the case when the patient's body exhibits hypersensitivity to the ingredients of the drug and butyrophenone derivatives.

Other antipsychotic and atypical antipsychotic drugs, as well as necessary antidepressants, may also be included in the treatment protocol.

For example, this could be moclobemide (Aurorix), imipramine (melipramine), befol, citalopram (cipramil), amitriptyline, cymbalta (duloxetine), trimipramine (gerfonal) and many others.

The antidepressant and sedative, amitriptyline, is prescribed to the patient for oral administration, without chewing, immediately after eating - this will reduce irritation of the mucous membrane of the digestive tract.

The medicine is taken in several doses: the maximum dose is administered immediately before bedtime. For an adult patient, this dosage is 25 - 50 mg. Gradually, in small amounts, the initial figure is increased to 150 - 200 mg per day, divided into three doses, while the time for this increase is from five to six days.

If the therapeutic effect is not visible within two weeks, the daily amount of the administered drug is increased to 300 mg. If the depressive symptoms have disappeared, the prescribed amount of the drug, on the contrary, is gradually reduced to 50 - 100 mg per day.

The duration of treatment is on average at least three months.

For elderly people with a mild degree of disorder, dosages are prescribed that fall within the range of 30 to 100 mg per day, and after achieving therapeutic effectiveness, the administered amount of the drug is reduced to 25–50 mg per day.

If necessary, the use of other forms of release of the medicinal product in question is permitted.

Amitriptyline can be administered as a solution intravenously or intramuscularly. The rate of drug delivery is slow. The starting dose is 20-40 mg four times a day. Injections are gradually replaced by tablet form of administration.

The duration of the treatment course is no more than six to eight months.

The dosage for children from six to twelve years old is 10-30 mg, or calculated as 1-5 mg daily per kilogram of the little patient’s weight, divided into several doses.

For adolescents over 12 years old - 10 mg three times a day. In case of medical necessity, the amount of the administered drug can be increased to 100 mg per day.

Contraindications for use include the acute phase or recovery period after myocardial infarction, closed-angle glaucoma, acute alcohol poisoning, the presence of intraventricular conduction in the patient's body, simultaneous treatment with MAO inhibitors, as well as hypersensitivity to the components of the drug and amitriptyline.

Any hallucinations, including auditory ones, are treated according to a strictly individual scheme, because the source of pathological deviations in each person can be different and consist of many different factors.

If it turns out that the cause of the abnormal noise is a malfunction of the hearing aid, then, naturally, you should contact an audiologist, check the device and, if necessary, replace it with a working one.

Prevention of imperative hallucinations

It is quite difficult to give any specific advice or recommendations in this situation. The only thing that can be included in the subsection "prevention of imperative hallucinations" is a few pieces of advice:

• Maintain a healthy lifestyle.
• Learn to avoid stressful situations.
• Avoid intense physical and mental stress and exhaustion.
• Give up bad habits, especially those related to hallucinogens.

Oddly enough, such simple advice will reduce the risk of developing a disorder known in medicine as imperative hallucinations several times over.

Prognosis of imperative hallucinations

If hallucinations join the pathological symptoms during the development of a mental illness, doctors note a deterioration in the patient's condition and a complication of the clinical picture of the disease. Imperative hallucinations are auditory hallucinations that sound in the ears of a sick person like an order. Quite often, the voices heard have a criminal-sadistic tone, prompting an action that poses a danger either to the person himself or to those around him. If timely measures are not taken and the patient is not subsequently kept on maintenance therapy, the prognosis for imperative hallucinations is very deplorable.

If measures are taken too late or the symptoms are ignored, then the patient may die. The disease in question is often observed in people prone to suicidal or homicidal actions.

Even a healthy person, having heard some whisper and not finding its source, feels very uncomfortable in such a situation, and what can we say about a sick person. Auditory deceptive sensations that have an aggressive imperative character - imperative hallucinations - are a rather serious and dangerous disease, which can be stopped only by a highly qualified specialist. Therefore, if you have even the slightest suspicion about yourself or about your loved one, it is better to consult a doctor. The main thing is not to miss the onset of the disorder, when it can still be controlled with fairly gentle medications. Such a patient, against the background of drug therapy, is able to lead a fairly high-quality social life. But if the moment is missed and the disease progresses, it is necessary to treat the disease, but now you will have to put in much more effort and patience, and the result is quite difficult to predict.